Computational Comparison Between Normal and Bicuspid Aortic Valve Hemodynamics

2011 ◽  
Author(s):  
Santanu Chandra ◽  
Clara Seaman ◽  
Nalini M. Rajamannan ◽  
Philippe Sucosky
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Large Degree ◽  
Left Ventricular ◽  
Cardiac Anomaly ◽  
Rapid Progression ◽  
Effective Orifice Area ◽  
Calcific Aortic Valve Disease ◽  
Congenital Cardiac Anomaly ◽  
Hemodynamic Stresses

The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is present in 2% of the population. While a normal tricuspid aortic valve (TAV) consists of three leaflets, a BAV is formed with only two as a result of the fusion of two leaflets into a larger one1. This defect is associated with serious complications such as calcific aortic valve disease (CAVD), a condition characterized by the accumulation of calcium on the leaflets which contributes to the obstruction of the left ventricular outflow and progressive heart failure. Although studies have suggested similarities in the pathogenesis of CAVD in the BAV and TAV, the calcification of the BAV is more severe and its progression more rapid. Previous studies in our laboratory have evidenced the sensitivity of valve leaflets to their hemodynamic environment and the ability of fluid stress alterations to trigger an inflammatory response on the aortic surface of porcine aortic valve leaflets2. Although a similar mechano-etiology could contribute to the rapid calcification of the BAV, it is not clear how the particular BAV anatomy impacts on its hemodynamic environment and whether the hemodynamic stresses experienced by BAV leaflets differ from those present in TAV leaflets. Therefore, the aim of this study was to characterize BAV hemodynamics and to quantify its degree of abnormality relative to a TAV. A fluid-structure interaction (FSI) approach validated with respect to particle-image velocimetry (PIV) measurements was implemented to quantify TAV and BAV hemodynamics in terms of flow velocity field, valvular effective orifice area (EOA) and leaflet wall-shear stress. The large degree of hemodynamic abnormality predicted in the BAV model may contribute to the rapid progression of CAVD in that anatomy. This work lays the foundation for future mechanobiological studies aimed at investigating the isolated effects of native BAV hemodynamic stresses on the development of CAVD.

Role of Hemodynamic Shear Stress Abnormalities in the Early Pathogenesis of Bicuspid Aortic Valve Calcification

2013 ◽  
Author(s):  
Ling Sun ◽  
Santanu Chandra ◽  
Philippe Sucosky
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
The United States ◽  
Cardiac Anomaly ◽  
Type I ◽  
Calcific Aortic Valve Disease ◽  
Congenital Cardiac Anomaly ◽  
Valvular Calcification ◽  
Right Coronary Cusp

With a prevalence of 1.3 million cases in the United States, the bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is frequently associated with calcific aortic valve disease (CAVD) [1]. The most prevalent type-I morphology, which results from left-/right-coronary cusp fusion, generates different hemodynamics than a tricuspid aortic valve (TAV). While valvular calcification has been linked to genetic and atherogenic predispositions, hemodynamic abnormalities are increasingly pointed as potential pathogenic contributors [2–3]. In particular, the wall shear stress (WSS) produced by blood flow on the leaflets regulates homeostasis in the TAV. In contrast, WSS alterations cause valve dysfunction and disease [4]. While such observations support the existence of synergies between valvular hemodynamics and biology, the role played by BAV WSS in valvular calcification remains unknown. The objective of this study was to isolate the acute effects of native BAV WSS abnormalities on CAVD pathogenesis.

scholarly journals Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

2012 ◽  
Vol 2012 ◽  
pp. 1-16 ◽  
Author(s):  
Katie L. Losenno ◽  
Robert L. Goodman ◽  
Michael W. A. Chu
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Aortic Aneurysms ◽  
Valve Disease ◽  
Cardiac Anomaly ◽  
Aortic Dilatation ◽  
Congenital Cardiac Anomaly ◽  
Valvular Stenosis ◽  
Ongoing Surveillance

The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms.

Abstract 141: Bicuspid Aortic Valve Hemodynamic Abnormalities Promote Early Development of Calcific Aortic Valve Disease

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Ling Sun ◽  
Santanu Chandra ◽  
Philippe Sucosky
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Osteogenic Differentiation ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Tissue Response ◽  
Valve Disease ◽  
Type I ◽  
Calcific Aortic Valve Disease ◽  
Congenital Cardiac Anomaly

INTRODUCTION: The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is frequently associated with calcific aortic valve disease (CAVD). Although CAVD also develops in the normal tricuspid aortic valve (TAV), its progression in the BAV is more rapid. While the accelerated calcification of BAV leaflets has been linked to genetic and atherogenic predispositions, hemodynamic abnormalities are increasingly pointed as potential pathogenic contributors. HYPOTHESIS: Supported by our previous work, which demonstrated the sensitivity of valve leaflets to the surrounding blood flow and associated wall-shear stress (WSS), we hypothesize that the abnormal WSS experienced by BAV leaflets contribute to CAVD development by promoting valvular inflammation, remodeling and osteogenic differentiation. OBJECTIVE: This study aims at comparing ex vivo the effects of TAV and BAV leaflet WSS on valvular pathogenesis. METHODS: The native, side-specific WSS experienced by TAV and type-I (i.e., fused and non-coronary) BAV leaflets were obtained computationally using fluid-structure interaction simulations. Fresh porcine leaflets were subjected for 48 hours to each of the three WSS conditions using a novel double-sided shear stress bioreactor. Tissue response was characterized via Western blot and immunohistochemistry in terms of markers of endothelial activation (VCAM-1, ICAM-1), paracrine expression (BMP-4), TGF-β/Wnt signaling pathways (TGF-β1, β-catenin), extracellular matrix remodeling (cathepsin L, MMP-2, MMP-9) and osteogenic differentiation (α-SMA, osteocalcin). RESULTS: No significant differences in VCAM-1 and ICAM-1 expressions were detected between tissue exposed to TAV and BAV WSS. While the native WSS experienced by the TAV and non-coronary BAV leaflets maintained tissue homeostasis, tissue exposure to the fused BAV leaflet WSS resulted in a significant pathological response marked by the upregulations of BMP-4, β-catenin, MMP-2 and osteocalcin expressions. CONCLUSION: This study demonstrates the pathological nature of the native BAV hemodynamics and confirms the higher susceptibility of the fused BAV leaflet to calcify. The results provide new insights into the hemodynamic theory of BAV calcification.

Fluid-Structure Interaction Predictions of Ascending Aorta Hemodynamics Under Tricuspid and Bicuspid Aortic Valve Flows

2013 ◽  
Author(s):  
Kai Cao ◽  
Philippe Sucosky
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Elastic Fiber ◽  
Ascending Aorta ◽  
Cardiac Anomaly ◽  
Type I ◽  
Matrix Remodeling ◽  
Structural Wall ◽  
Congenital Cardiac Anomaly ◽  
Right Coronary Cusp

The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is present in 2–3% of the general population. As compared to the normal tricuspid aortic valve (TAV) which consists of three leaflets, the most prevalent type-I BAV morphology forms with two as a result of left-/right-coronary cusp fusion. While the BAV anatomy may not intrinsically hamper valvular function, it is associated with a spectrum of secondary aortopathy such as aortic dilation and subsequent dissection. The dilation and thinning of the ascending aorta downstream of a BAV is marked by structural wall abnormalities including smooth muscle cell depletion, elastic fiber degeneration and abnormal extracellular matrix remodeling, which localize to the convexity of the aortic wall.

Quadricuspid aortic valve and a large patent ductus arteriosus treated with device closure

2021 ◽  
pp. 1-5
Author(s):  
Mehboob Sultan ◽  
Khush Bakht Awan ◽  
Asad Khan
Keyword(s):  
Aortic Valve ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Cardiac Anomaly ◽  
Quadricuspid Aortic Valve ◽  
Device Closure ◽  
Congenital Cardiac Anomaly ◽  
Aortic Root Dilatation ◽  
Patent Ductus

Abstract Quadricuspid aortic valve is a remarkably rare congenital cardiac anomaly that predominantly becomes regurgitant with the passage of time. Aortic valve stenosis and aortic root dilatation are less common in quadricuspid aortic valve as compared to bicuspid aortic valve. The clinical presentation depends upon the functional status of the aortic valve, left ventricular function, and associated cardiac or coronary anomalies. The quadricuspid aortic valve is easily visualised during transthoracic echocardiogram with a characteristic X pattern of aortic valve in diastole. The association of quadricuspid aortic valve with patent ductus arteriosus is exceedingly rare. We are reporting a case of young girl with mildly regurgitant quadricuspid aortic valve, large patent ductus arteriosus, and volume-loaded left heart who underwent a successful device closure of her patent ductus arteriosus. To the best of our knowledge, such a case is being reported from Pakistan for the first time.

The circle method for preoperative TAVI sizing in a Sievers type 0 stenotic bicuspid aortic valve

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Circle Method ◽  
Ascending Aorta ◽  
Cardiac Anomaly ◽  
Aortic Valves ◽  
Congenital Cardiac Anomaly ◽  
Video Tutorial ◽  
Transcatheter Heart Valve ◽  
Valve Annulus

The most common congenital cardiac anomaly, affecting an estimated 0.4–2.25% of the general population, is the bicuspid aortic valve. The “pure” bicuspid aortic valve (non-raphe-type or bicuspid aortic valve type 0) is composed of 2 cusps, morphologically and functionally. The shape of the bicuspid aortic valve annulus is often elliptical, is relatively larger than the tricuspid aortic valves, and probably shows severe eccentric calcification. This situation contributes to the difficulties in selecting the correct type and size of transcatheter heart valve when treating bicuspid aortic valve stenosis. Furthermore, it is often associated with a dilated, horizontal ascending aorta and effaced sinuses. The goal of our video tutorial is to present the contemporary circle method used in preoperative sizing during TAVI procedures in patients with a bicuspid aortic valve as well as certain technical considerations and useful advice. Although annular sizing is the main focus for most patients with a bicuspid aortic valve, some patients may need the supra-annular level of sizing. For a dedicated sizing and positioning approach for the SAPIEN 3 Ultra valve, experts in the field propose the circle method.

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